采用β_2-MG和血气分析评价AHH联合CH脊柱手术对患者血液内环境及肾功能的影响
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摘要
目的采用_(β2)-微球蛋白(β_2-MG)和血气分析评价急性高容量血液稀释(AHH)联合控制性降压(CH)脊柱手术对患者血液内环境及肾功能的影响。方法将90例择期脊柱手术患者随机分为AHH+CH组和CH组,每组45例。AHH+CH组按15mL/kg以30mL/min的速率输注6%羟乙基淀粉130/0.4,使血容量增加20%左右,同时以微量泵输注硝酸甘油行CH,速度为1μg·kg·min,平均动脉压控制在65~75mm Hg。CH组仅行CH,降压方法同AHH+CH组。记录两组术中失血量、输血量。于置管后AHH前(T_0)、AHH后CH前(T_1,CH组为置管后CH前)、CH后30min(T_2)和停止CH后30min(T_3)测定两组动脉血pH值、剩余碱(BE)及K~+、Na~+、Ca~(2+)、Cl~-水平。采用全自动生化分析仪测定血浆尿素氮(BUN)水平,采用酶联免疫吸附法测定血浆_(β2)-MG水平。结果 AHH+CH组术中失血量、输血量明显少于CH组,差异有统计学意义(P<0.05);与T_0及CH组比较,AHH+CH组T_1、T_2、T_3时pH值明显降低,差异有统计学意义(P<0.05),BE、K~+、Na~+、Ca~(2+)、Cl~+无明显变化;AHH+CH组T_1时BUN、β_2-MG水平较T_0时明显下降,差异有统计学意义(P<0.05),T_1、T_2、T_3时明显低于CH组同时间节点水平,差异有统计学意义(P<0.05)。与T_l时比较,CH组T_2、T_3时BUN、β_2-MG水平明显升高,差异有统计学意义(P<0.05)。结论 AHH联合CH对患者的内环境影响较小,且可改善单纯CH导致的肾小球滤过率降低。
Objective To evaluate the influence of acute hypervolemic hemodilution combined with controlled hypotension on homeostasis and renal function in patients with spinal operation by usingβ_2-microglobulin(β_2-MG)and blood gas analysis.Methods 90cases of patients with spinal operation were divided randomLy into AHH+CH group and CH group,45cases in each group.In AHH+CH group,6%hydroxyethyl starch solution 15mL/kg was infused at a rate of 30mL/min before skin incision,at the same time nitroglycerin was infused at a rate of 0.5-5μg/kg/min and MAP was maintained at 70%of the base level.Controlled hypotension was implemented in CH group according to the methods of AHH+CH group.Intraoperative blood loss and allogeneic blood transfusion were recorded in two groups.Arterial blood pH,residual base(BE)and K~+,Na~+,Ca~(2+),Cl~-concentration at T_0(after cathetering,prior to AHH),T_1(after AHH for AHH+CH group,after cathetering for CH group),T_2(30min after CH),T_3(30min after stopping CH)were determinated in two groups.Plasma BUN levels were determinated by using the automatic biochemical analyzer,plasmaβ_2-MG levels were determinated by using the enzyme-linked immunosorbent assay.Results Intraoperative blood loss and allogeneic blood transfusion in AHH+CH group were less significantly than those in CH group,the difference was statistically significant(P<0.05).Compared with those at T_0and in CH group,pH value decreased significantly,the difference was statistically significant(P<0.05)and BE,K~+,Na~+,Ca~(2+),Cl~-had no obvious changes at T_1,T_2,T_3in AHH+CH group.Compared with that at T_0,plasma BUN andβ_2-MG levels at T_1decreased,the difference was statistically significant(P<0.05)in AHH+CH group,and the level at T_1,T_2,T_3was lower significantly than those in CH group,the difference was statistically significant(P<0.05).Compared with that at T_1,plasma BUN andβ_2-MG levels at T_2,T_3increased significantly in CH group,the difference was statistically significant(P<0.05).Conclusion AHH combined CH has less influence on the patient′s internal environment,and can improve the glomerular filtration rate decreased caused by CH.
Objective To evaluate the influence of acute hypervolemic hemodilution combined with controlled hypotension on homeostasis and renal function in patients with spinal operation by usingβ_2-microglobulin(β_2-MG)and blood gas analysis.Methods 90cases of patients with spinal operation were divided randomLy into AHH+CH group and CH group,45cases in each group.In AHH+CH group,6%hydroxyethyl starch solution 15mL/kg was infused at a rate of 30mL/min before skin incision,at the same time nitroglycerin was infused at a rate of 0.5-5μg/kg/min and MAP was maintained at 70%of the base level.Controlled hypotension was implemented in CH group according to the methods of AHH+CH group.Intraoperative blood loss and allogeneic blood transfusion were recorded in two groups.Arterial blood pH,residual base(BE)and K~+,Na~+,Ca~(2+),Cl~-concentration at T_0(after cathetering,prior to AHH),T_1(after AHH for AHH+CH group,after cathetering for CH group),T_2(30min after CH),T_3(30min after stopping CH)were determinated in two groups.Plasma BUN levels were determinated by using the automatic biochemical analyzer,plasmaβ_2-MG levels were determinated by using the enzyme-linked immunosorbent assay.Results Intraoperative blood loss and allogeneic blood transfusion in AHH+CH group were less significantly than those in CH group,the difference was statistically significant(P<0.05).Compared with those at T_0and in CH group,pH value decreased significantly,the difference was statistically significant(P<0.05)and BE,K~+,Na~+,Ca~(2+),Cl~-had no obvious changes at T_1,T_2,T_3in AHH+CH group.Compared with that at T_0,plasma BUN andβ_2-MG levels at T_1decreased,the difference was statistically significant(P<0.05)in AHH+CH group,and the level at T_1,T_2,T_3was lower significantly than those in CH group,the difference was statistically significant(P<0.05).Compared with that at T_1,plasma BUN andβ_2-MG levels at T_2,T_3increased significantly in CH group,the difference was statistically significant(P<0.05).Conclusion AHH combined CH has less influence on the patient′s internal environment,and can improve the glomerular filtration rate decreased caused by CH.
引文
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[9]王继辉,张庆.急性高容量血液稀释联合控制性降压对脊柱手术患者全身炎性反应的影响[J].临床麻醉学杂志,2015,31(2):148-150.
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[12]陈勇,夏克枢,陈涛.羟乙基淀粉130/0.4氯化钠注射液预扩容对腰硬联合麻醉下剖产患者血流动力学的影响[J].中国预防医学杂志,2016,10(17):768-771.
[13]翟虎,戴文漪,尤胜义.腹部大手术后应用羟乙基淀粉130/0.4液体治疗的临床研究[J].齐齐哈尔医学院学报,2012,33(24):3333-3335.
[14]张壮,张绍丽.两种人工胶体液用于心脏手术容量治疗的临床观察[J].临床麻醉学杂志,2012,28(8):817-818.
[15]吴亚,曹爽,郭欣,等.国产羟乙基淀粉用于ANH对老年全膝关节置换术患者肾功能的影响[J].中国输血杂志,2017,30(5):510-513.
[2]张学康,赵为禄,闵佳,等.急性高容量血液稀释联合瑞芬太尼控制性降压对颅内动脉瘤术患者血流动力学和脑氧代谢的影响[J].临床麻醉学杂志,2012,28(2):109-112.
[3]熊华平,吴志云,查本俊.急性高容量血液稀释联合控制性降压用于全髋关节置换术患者的临床观察[J].临床军医杂志,2015,43(11):1173-1177.
[4]魏淑明.急性高容性血液稀释对顺式阿曲库铵药效学的影响[J].泰山医学院学报,2012,33(1):34-37.
[5]谭兴中,岳永猛,柏明荣,等.急性高容量血液稀释联合控制性降压用于鼻内窥镜手术血液保护效果观察[J].四川医学,2013,34(8):1156-1158.
[6]边冬梅,王晓娟,倪秀梅,等.急性高容量血液稀释联合右美托咪啶、硝酸甘油控制性降压在脊柱侧弯矫正术中的应用[J].实用临床医药杂志,2013,17(5):36-39.
[7]钟锦秀,张培冰.急性高容性血液稀释联合控制性降压在人工全髋关节置换术中的应用[J].中国医药导刊,2015,17(6):602-604.
[8]孙梅杰,边雯,李慧禄,等.瑞芬太尼控制性降压对老年患者鼻内镜术后认知功能和脑氧代谢的影响[J].中国老年学杂志,2014,37(9):2358-2360.
[9]王继辉,张庆.急性高容量血液稀释联合控制性降压对脊柱手术患者全身炎性反应的影响[J].临床麻醉学杂志,2015,31(2):148-150.
[10]孙斌,钱宝华.围手术期血液保护的策略[J].中国输血杂志,2013,26(9):922-925.
[11]梁华,丁志刚,刘晓华,等.急性高容量血液稀释联合控制性降压对老年脊柱手术患者内稳态及术后认知功能的影响[J].宁夏医科大学学报,2015,37(4):400-404.
[12]陈勇,夏克枢,陈涛.羟乙基淀粉130/0.4氯化钠注射液预扩容对腰硬联合麻醉下剖产患者血流动力学的影响[J].中国预防医学杂志,2016,10(17):768-771.
[13]翟虎,戴文漪,尤胜义.腹部大手术后应用羟乙基淀粉130/0.4液体治疗的临床研究[J].齐齐哈尔医学院学报,2012,33(24):3333-3335.
[14]张壮,张绍丽.两种人工胶体液用于心脏手术容量治疗的临床观察[J].临床麻醉学杂志,2012,28(8):817-818.
[15]吴亚,曹爽,郭欣,等.国产羟乙基淀粉用于ANH对老年全膝关节置换术患者肾功能的影响[J].中国输血杂志,2017,30(5):510-513.